Runners Knee

Runners Knee 101

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A Brief History on Runners Knee

Runners knee is the nickname for Patellofemoral Pain Syndrome (PFPS) as its effects most commonly occur with runners. The patella, which we refer to as our kneecap, is said to not be “tracking’’ correctly within its groove.  How the patella rests on the thighbone will determine whether PFPS will become a problem.  The function of our kneecap is to support various motions we do in everyday life, as we flex, extend and rotate our legs in all different movements. This is why runners knee will cause irritation on a daily basis and almost unavoidable. Sitting, squatting and even walking on an uneven floor can all be factors of discomfort.

Signs and symptoms can vary when experiencing this problem. Some cases of runners knee can feel immediate and almost traumatic, others feel mild, before becoming increasingly painful as a chronic issue. The feeling can recur during cardiovascular activity, as it disappears and becomes present yet again

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Causes of Runners Knee

Is it biomechanical?

In some cases, runners knee is heredity. Certain athletes are not naturally balanced from a biomechanical perspective, allowing the syndrome to grow problematically, if ongoing conditioning weren’t to take place.

The patella itself may be large in size, affecting how it sits on the femoral groove. This will cause flexion and extension of the thighbone to become very difficult. Also, a disproportioned kneecap can be dislocated much easier.  Issues with your feet can also play a role in PFPS. People who are flat footed can shift their patella in and out excessively, causing it to eventually situate itself more laterally and out of alignment. In a scenario where the patella is well developed, poorly imbalanced quads and hamstrings is most likely the contributor to chronic wear and tear of the knee.

Don’t run yourself into problems?

It is very important to condition your legs properly for running activities. A poor training regiment can develop imbalances that lead to runners knee.

When the cause is not biomechanical, it’s most common that the quadriceps are not strong enough to hold your patella in place.  The inner quads are most functional for keeping the knee in tracking position.  Opposite muscles (agonists and antagonists) must always be kept equally strong so muscle groups don’t compensate for each other and become weaker. For this reason, your hamstrings and calves being tight can be primarily the reason why the patella and quadriceps fail to work together over time. Identifying PFPS can be difficult but it is necessary to visit the physiotherapist if in any doubt. From reading my article on IT Band Syndrome, runners knee can be chaotic if not treated. 

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Primary Signs & Symptoms of Runners Knee

Firstly, the chief complaint for systematic will be pain around the patella.

The origin of the pain will feel like its triggering from behind the knee, radiating around the sides to the front, and resulting on each side of the kneecap at the center.

The most typical motions that aggravate runners knee syndrome are said to be prolonged sitting, running uphill or downhill (downhill more so), running with an increase in acceleration, walking up and down stairs and weight bearing exercises such as squatting.  While running, the person suffering from PFPS will describe the feeling as the knee is about to ‘’give out” and traumatically lose all function.

Ways Of Prevention


First of all, protect yourself by what you wear. If your feet have a natural tendency to roll inward, then the arched gap between your foot and the sole of your shoe will weaken your knee and cause it to shift to the side. Orthotics that can close the gap would be highly recommended. To make things better, having a clinician fit the right runner and correct orthotics ensures better safety.

Adapting To Terrain

The surface you train on is extremely important. Making dramatic changes to the terrain you run on, can cause your knee to become unstable due to poor conditioning. Progress by training first on a lighter surface, one that’s even, before testing upward and downward hills. Supporting muscle groups need to be conditioned gradually for this reason too.

Weight Training

The supporting muscles need ongoing conditioning off the track.

From your core down, it is essential to keep the following strong and functional:

·      Hip Abductors

·      IT Band

·      TFL

·      Gluteus Medius/Max

·      Quadriceps

·      Hamstrings

·      Calves


Listen To Your Body

If your body is telling you to lighten the intensity of your next run, listen.

You will need to lighten the load, even if you progress. Causing wear and tear to the supporting muscle groups and knee cartridge can happen.  Remember to take rest days.


Treating Runners Knee

Strength Training Program

You will have to train the muscle groups as I mentioned above, but from a more bearable perspective that you can manage once PFPS becomes an issue.

1.     Hip Abductors

Lying on your side, perform leg lifts with or without a theraband.

Turn the toe of the leg you are lifting towards the floor. This way you will activate your hip abductors more. Do this over several repetitions.

Seated clamshells using the band are also a great way to target these muscles lying on your side.


  2.     Quadriceps

Straight leg lifts from the floor will target the quadriceps and hip flexors.

Point the toe downwards to feel more activation.


3.     Glute Medius/Maximus

Theraband Steps with an agility ladder. Step into the middle space of each step and step laterally to the sides of the ladder to activate glutes.

30 Degree Side Squats with a theraband. Squat as you step laterally to the side. And push the foot on the outside back to starting position.

Balance exercises with A BOSU Ball. Holding dumbbells, step on and off ball to activate the same target areas.


4.     Foam Rolling

It is important to keep the muscles loose and not let them become tight and develop imbalances. It is important to foam roll the lower body. The IT band should be rolled from the hip to the knee. The quads, hams, glutes and calves are also essential.


5.     Ice And Rest

It is important to ice after each run, especially if there is any swelling. Elevating and resting the leg can also help recovery after treatment.


6.     Stretching

All the muscles we have stated above should be stretched after running activity. Hold each static stretch for 45 seconds before release.


7.     Aqua Fitness

Water Resistance can be a great to exercise the lower body and test your flexors/rotators in a safe environment. You can simulate running movements and target supporting compartments of the knee efficiently.


8.     Kinesiology Taping

Taping can simply just reduce the pain and swelling of PFPS. Some athletes either prefer to use tape or a brace to give relief.

Read more about runners knee on the link bellow:

Ben Walker is a Your House Fitness personal trainer based in Toronto, ON. To view his profile click on his name.